Ito Naruhiko, Kurabayashi Manabu, Okishige Kaoru, Hirao Kenzo
Division of Cardiology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shin-Yamashita, Naka-Ward, Yokohama, Japan.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ward, Tokyo, Japan.
Eur Heart J Case Rep. 2018 Jul 3;2(3):yty074. doi: 10.1093/ehjcr/yty074. eCollection 2018 Sep.
Coronary artery spasm usually has a good prognosis, except when it induces lethal ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) implantation in addition to optimal medical therapy including prescription of coronary vasodilators and smoking cessation is a therapeutic option for coronary artery spasm patients who present with lethal ventricular arrhythmia. Subcutaneous ICDs are now available as an alternative to conventional transvenous ICDs.
We report the first case of a 50-year-old Japanese male without any structural heart disease who presented with ventricular fibrillation caused by coronary artery spasm, and underwent subcutaneous ICD implantation for secondary prevention of sudden cardiac death (SCD). We attributed his aborted SCD to coronary artery spasm based on findings of cardiac catheterization including acetylcholine provocation test and cardiac electrophysiological study. During the 1 year of follow-up, the patient discharged on calcium channel blockers and nicorandil has been free of angina, ventricular arrhythmias, and appropriate ICD therapy.
Coronary artery spasm patients with aborted SCD may be good candidates for implantation of subcutaneous ICDs, because most of them have no need for concomitant bradycardia therapy, cardiac resynchronization therapy, or anti-tachycardia pacing therapy.
冠状动脉痉挛通常预后良好，除非诱发致命性室性心律失常。除了包括冠状动脉扩张剂处方和戒烟在内的最佳药物治疗外，植入式心脏复律除颤器（ICD）植入术是患有致命性室性心律失常的冠状动脉痉挛患者的一种治疗选择。皮下ICD现在可作为传统经静脉ICD的替代方案。
我们报告首例50岁无任何结构性心脏病的日本男性患者，因冠状动脉痉挛导致心室颤动，并接受皮下ICD植入术以进行心脏性猝死（SCD）的二级预防。基于包括乙酰胆碱激发试验和心脏电生理研究在内的心脏导管检查结果，我们将其未遂SCD归因于冠状动脉痉挛。在随访的1年中，服用钙通道阻滞剂和尼可地尔出院的患者未出现心绞痛、室性心律失常及ICD恰当治疗。
发生未遂SCD的冠状动脉痉挛患者可能是皮下ICD植入的合适人选，因为他们大多数不需要同时进行心动过缓治疗、心脏再同步治疗或抗心动过速起搏治疗。
